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NHS National Services Scotland — Supporting Scotland's Health Clinical Negligence & Other Risks Indemnity Scheme (CNORIS) Annual Report 2015-16
Transcript of CLO - Central Legal Office - Table of Contents:€¦ · Web viewThe peak in value during 1999-00...
NHS National Services Scotland — Supporting Scotland's Health
Clinical Negligence & Other Risks Indemnity Scheme
(CNORIS)
Annual Report 2015-16
Scheme Director: Fiona Murphy
NHS National Services Scotland
Date Published: July 2016
Please contact the Scheme Manager, Irene A Hallett ([email protected]) , for all enquiries.
NHS National Services Scotland — Supporting Scotland's Health
Table of Conten ts:
Introduction................................................................................................................................... 3Outturn for 2015-16................................................................................................................... 3Table 1: CNORIS Payments by Members 2015-16........................................................... 4
Incident Timeline........................................................................................................................... 4Graph 1: Claims Paid 2015-16 by Year of Incident............................................................ 4
Trends in Payments..................................................................................................................... 5Table 2: Payments made since 2005-06............................................................................... 5
Graph 2: Value of Claims Paid during 2013-14, 2014-15 & 2015-16.................................... 6
Graph 3: Number of Claim Payments made during 2013-14, 2014-15 & 2015-16............... 6
Periodic Payment Orders and Structured Settlements 2015-16........................................... 7Contributions and Claims Paid.................................................................................................... 7Graph 4: Contributions & Claims Paid – 3 Year Total........................................................... 7
Analysis of Claims by Year of Incident and Year Received...................................................... 8Graph 5: Breakdown of No. of All Claims.............................................................................. 8
Graph 6: Breakdown of CNORIS Payments 2005-06 and 2015-16...................................... 9
Graph 7: CNORIS Payments made 2005-06 and 2015-16 by Speciality Group................... 10
Graph 8: CNORIS Payments by Years of Incidents and Claims Received........................... 11
Pipeline Analysis........................................................................................................................... 12Graph 9a: Pipeline Analysis of Open Claims......................................................................... 12
Graph 9b: Pipeline Analysis of Open claims (adjusted for risk)............................................. 12
Appendix 1: Background, Definitions, and Key Delivery Partners………………………......... 13Appendix 2: Organisations covered by CNORIS........................................................................14Notes ............................................................................................................................................. 15
NHS National Services Scotland — Supporting Scotland's Health
IntroductionClinical Negligence and Other Risks Indemnity Scheme (CNORIS) is a risk transfer and financing scheme for Health and Social Care across Scotland and was first established in 1999 by the Scottish Government Health Directorates in partnership with Willis Limited. The primary objective is to provide cost-effective risk pooling and claims management arrangements for members of the Scheme who include: NHS Health Boards, Special Health Boards and Health & Social Care Integration Joint Boards from across Scotland1.
With effect from the 1st September 2013 NHS National Services Scotland (NSS) took over responsibility for managing the Scheme from Willis Limited, with the NHS Central Legal Office continuing to provide legal advice and guidance to members in relation to negligence claims.
This year’s annual report provides summary details of the number and value of claims made during the financial year 2015-16, and gives an insight into arrangements for payment of clinical negligence claims and the impact on NHS Scotland2. The NHS in Scotland treats some 4.5 million outpatients and 1.5 million inpatients each year in hospitals in Scotland3. There is a very high standard of care and patient safety. The total number of claims upheld for clinical negligence4 each year is small although the financial value can be high depending on the nature of the claim and the impact on the patient.
The CNORIS scheme covers both clinical and non clinical claims5. In 2015-16 there were 291 claim payments made, this was higher than in previous years and a 14% increase on last year’s figure of 255. The total value of claims was £52.8 million which was a 36.9% increase on the £38.6 million claimed in 2014-15. The split in claims showed that 235 totalling £49.7 million related to clinical claims while 56 totalling £3.1 million were non-clinical. The highest settlements were in obstetric care and, as illustrated in Graph 2 below, these type of claims can take many years to conclude due to a number of factors.
It should be noted that although a claim may have been received in 2015-16 it often relates to an incident that occurred many years previously. Of the claims received in 2015-16 there were only 15 of the 291 where the incident date was between 2013-14 and 2015-16. This highlights the lengthy time for some claims to reach a resolution and is not necessarily indicative of an increasing number of incidents compared with previous years. This is analysed in greater detail in Graph 1.
Outturn for 2015-16
The value of claims settled in 2015-16 was £52.8 million. Taking account of the carry-forward of £0.2 million from 2014-15, the total commitment on the pool in 2015-16 was £53.0 million.
The breakdown of the number and value of claim payments made during 2015-16 is detailed in Table 1 below. Of these payments, 27 related to high value cases (where settlement is over £1 million) and of these, 9 payments, all of which related to clinical claims, were in excess of £1 million.
NHS National Services Scotland — Supporting Scotland's Health
Table 1: CNORIS Payments by Members 2015-16
CNORIS Member Number of Claims* Value of Claims(£ 000’s)
NHS Ayrshire and Arran 23 2,138NHS Borders <5 723NHS Dumfries and Galloway 8 312NHS Fife 10 774NHS Forth Valley 11 1,831NHS Grampian 22 4,554NHS Greater Glasgow and Clyde 70 15,695NHS Highland 22 2,079NHS Lanarkshire 25 11,424NHS Lothian 56 5,935NHS Orkney <5 0NHS Shetland <5 143NHS Tayside 23 5,642NHS Western Isles <5 131NHS 24 <5 10National Waiting Times Centre <5 23Scottish Ambulance Service 9 1,390TOTAL 291 52,805
*Where the numbers of claim payments are less than 5 then “<5” is entered in column 2 above.
Incident Timeline
Graph 1: Claims Paid 2015-16 by Year of Incident
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Number of Claims by Incident Year
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Incident Year
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Valu
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NHS National Services Scotland — Supporting Scotland's Health
The above graph shows for all claims paid in 2015-16 the value and number of claims attributed to the year of incident. The majority of claims are settled more than 5 years after the date of the incident, with some settlements taking considerably longer. The peak in value during 1999-00 relates to a single large claim worth over £7m that was claimed in 2015-16.
Trends in Payments
Table 2 below shows how payments over the last 10 years have risen from £4.45 million to £52.8 million, reflecting increasing volume and value of claims. Peak expenditure was in 2010-11 when claims, net of deductibles, totalled £58.25 million.
Table 2: Payments made since 2005-06
Payments made since 2005-06, Net of Deductibles, As at 31 March 2016*
Financial YearClinical & Residual
(£ million)Non - Clinical
(£ million)Total
(£ million)2005-06 4.1 0.3 4.52006-07 9.4 0.2 9.62007-08 18.3 0.6 18.92008-09 27.1 1.3 28.42009-10 30.8 0.3 31.12010-11 57.4 0.9 58.22011-12 27.1 2.0 29.22012-13 33.1 1.8 35.02013-14 34.9 3.5 38.42014-15 37.0 1.6 38.62015-16 49.7 3.1 52.8TOTAL 328.9 15.8 344.7
* Values relate to reimbursements made from CNORIS and not payments to claimants and their legal representatives.
The trend in the number and value of payments continues upwards, year on year. Of the 2015-16 payments, 27, totalling £26.98 million, relate to 25 cases where the total case value is greater than £1 million.
The breakdown of the number and value of claims by speciality highlights that obstetrics claims account for 42.8% of the total value of claims over the last 3 years (2013-14, 2014-15 & 2015-16), although only 16.3% of the number of claims. Refer to Graphs 2 and 3 below for the percentage breakdown of values and numbers of claims paid by specialty during 2013-14, 2014-15 and 2015-16.
NHS National Services Scotland — Supporting Scotland's Health
Graph 2: Value of Claims Paid during 2013-14, 2014-15 & 2015-16
Acciden
t and Em
ergen
cy
Anaestheti
cs
Clinica
l (uncla
ssified
)
Contaminate
d Blood (Pati
ent e
xposu
re)
Gynaec
ology
Healthcar
e Acquire
d Infec
tion
ITU / H
DU
Medica
tion Error (
excl a
naestheti
cs)
Obstetri
cs
Oncology
(excl R
adiology
and Su
rgery)
Radiologic
al Inves
tigation
Surge
ry (ex
cl obste
trics)
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l0.00%
20.00%
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60.00%
Claim Values by Speciality
2013-142014-152015-16
Speciality
% o
f Tot
al C
laim
s
Graph 3: Number of Claim Payments made during 2013-14, 2014-15 & 2015-16
Acciden
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ergen
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l (uncla
ssified
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fection
ITU / H
DU
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(excl
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and Su
rgery)
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al Inves
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trics)
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Claim Numbers by Speciality
2013-142014-152015-16
Speciality
% o
f Tot
al C
laim
s
NHS National Services Scotland — Supporting Scotland's Health
Periodic Payment Orders (PPOs) and Structured Settlements6 2015-16
The increasing number of PPOs will continue to affect the future profile of payments by CNORIS. At present there are 11 PPOs and 4 older structured settlements across 5 NHS Boards; one paid quarterly and the others annually, currently totalling £2.48 million each year, subject to inflation changes.
Contributions and Claims Paid
Contributions and claims paid in the last 3 years are illustrated in Graph 4 below. Contributions are set based upon a formula that includes claim history, more recent claims and an assessment of risk of incidents occurring. Contributions do not therefore match payments in a particular year.
Graph 4: Contributions & Claims Paid – 3 Year Total
NHS Ayrs
hire an
d Arran
NHS Borders
NHS Dumfrie
s and Gallo
way
NHS Fife
NHS Forth
Valley
NHS Gram
pian
NHS Grea
ter Glas
gow & Clyd
e
NHS High
land
NHS Lan
arkshire
NHS Lothian
NHS Orkn
ey
NHS Shetl
and
NHS Tays
ide
NHS West
ern Isl
es
Mental
Welf
are Commiss
ion
National W
aiting T
imes
Centre
NHS 24
NHS Educati
on
NHS Hea
lth Sc
otland
NHS Hea
lthcar
e Impro
vemen
t Sco
tland
NHS Nati
onal Serv
ices S
cotla
nd
Scottish Ambulan
ce Ser
vice
State
Hospita
ls Board
for S
cotla
nd0.005.00
10.0015.0020.0025.0030.0035.0040.00
3 Year Contributions vs Claims
3 Year Contributions 3 Year Claim Values
CNORIS Member
Valu
e (£
mill
ion)
NHS National Services Scotland — Supporting Scotland's Health
Analysis of Claims by Year of Incident and Year
Graph 5 below provides a breakdown of the total number of medical and nursing (clinical) claims for compensation together with all other claims for compensation, by the years the claims were received by NSS CLO. There has been a decrease in the number of claims received in 2015-16 compared with years 2013-14 and 2014-15.
It is important to bear in mind that this graph shows the total number of claims received each year regardless of amount and merit, and is not related to the number of claims that may eventually be a call on the CNORIS scheme, generally those in excess of £25,000 where responsibility is accepted or judgement is awarded.
Graph 5 - Breakdown of No. of All Claims Received by NSS CLO
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Breakdown of Claims Received by NSS CLO(by financial year in which received)
Total No of Other Claims
Total No of Medical & Nursing Claims
TOTAL NO of CLAIMS > £25K (CNORIS Threshold)
The bar chart element of the above graph illustrates the total number of claims received by CLO broken down between medical & nursing claims (Type 1 and 2) and all other claims (Types: 3 - 9,11 & 12), whilst the line graph element highlights those claims where the total cost (award payments plus adverse expenses, plus members' legal costs) was in excess of the £25K CNORIS threshold, or, for outstanding claims, the anticpated cost is likely to be above the threshold .
NHS National Services Scotland — Supporting Scotland's Health
Graph 6 below profiles claims where payments were made between 2005-06 and 2015-16 (total value of net payments made was £344.74 million), This shows the growth in the payments for all claims, but particularly obstetrics and gynaecology claims in the earlier years and that whilst obstetrics and gynaecology claims have levelled out, there is continued growth in other clinical claims reaching a record level in 2015-16, with these clinical claims increasing by 43.4% on the previous high observed in 2014-15.
Graph 6 – Breakdown of CNORIS Payments (£344.74 million, net of deductibles), made between 2005-06 and 2015-16
2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-160k
10,000k
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30,000k
40,000k
50,000k
60,000k
Claim Type Total Value
Financial Year
Valu
e (£
)
NHS National Services Scotland — Supporting Scotland's Health
Graphs 7 and 8 below analyse these same claim payments between April 2005 and March 2016 (£344.74 million). Graph 7 analyses, in percentage terms, how the payments over these years were divided between non-clinical and clinical, with a separate analysis of obstetrics and gynaecology claims. Graph 8 profiles the same period of payments, but analyses them by the years in which incidents that led to each claim occurred and also by the years in which these claims were received; highlighting how some claims can take many years to conclude. For claims paid in 2015-16, where dates are provided, the average period between the date of the incident to the date the claim was received by CLO was 2.74 years, with the median period being 1.89 years.
Graph 7 –CNORIS Payments (£344.74 million, net of deductibles), made between 2005-06 and 2015-16 by Specialty Group (Updated
2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-160.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Claim Type % of Total Value
Financial Year
Ove
rall
Clai
m %
NHS National Services Scotland — Supporting Scotland's Health
Graph 8: CNORIS Payments (2005-06 to 2015-16) by Year of Incident and Year Claim Received
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By Year of PaymentBy Year Claim ReceivedBy Year of Incident
NHS National Services Scotland — Supporting Scotland's Health
Pipeline Analysis7
A pipeline analysis of estimated values of open (unsettled) claims as they were at year ends for 2010-11 to 2015-16, broken down by clinical claims, obstetrics & gynaecology claims non-obstetrics & gynaecology claims, and non-clinical claims, is provided in Graph 9a below. In addition, the graph profiles the years in which the claims open “@ Year End 2016” were estimated to be settled (paid), although not all will settle above the CNORIS threshold.
However, this does not take into account the relevant risk profiles8 evaluating how many of these claims were anticipated to be settled in favour of the claimant. Graph 9b illustrates the significant reduction in estimated values when risk profiles are taken into account. There is also an impact on the estimated profile of settlements (payments). Both risks and settlement profiles will continue to be revised as claims advance through the legal process.
Graph 9a Graph 9b
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illio
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Graph 9a - Unadjusted* Total Estimated Value for Open Claims
Obstetrics & Gynaecology Claims Clinical - Non Obstetrics & Gynaecology Claims
Non-Clinical Claims Estimated Settlement Date Profiles
*Estimated settlement values have not been adjusted to reflect the risk (minimal , up to 50% and more than 50%) of settlement.
Line graph represents the estimated settlement values of those claims open @ Year End 2016, by the year in which they are currently estimated to settle.
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Graph 9b - Risk Adjusted*, Total Estimated Value for Open Claims
Obstetrics & Gynaecology Claims Clinical - Non Obstetrics & Gynaecology ClaimsNon-Clinical Claims Estimated Settlement Date Profiles
*Estimated settlement values have been adjusted to reflect the risk (minimal , up to 50% and more than 50%) of settlement.
Line graph represents the estimated settlement values of those claims open @ Year End 2016, by the year in which they are currently estimated to settle.
NHS National Services Scotland — Supporting Scotland's Health
Appendix 1: Background, Definitions, and Key Delivery Partners
Background to the CNORIS Scheme:
The scheme was established under the Clinical Negligence and Other Risk Indemnity Scheme (CNORIS) Scotland Regulations 2000 as amended9, with effect from 1 April 2000. Participation in the scheme is mandatory for all NHS Boards in Scotland with responsibility for delivering patient care. Private contractors including General Dental Practices and General Medical Practitioners (GPs) are outwith the scheme (they have their own indemnity scheme arrangements). GPs may be covered in instances where they have been directly employed by Health Boards (e.g. out of hours scheme).
With the introduction of the Public Bodies (Joint Working)(Scotland) Act10 from April 2015, the Scheme was broadened to enable Integration Joint Boards and Local Authorities to become Members.
Definitions of the CNORIS Scheme:
The Scheme - Clinical Negligence and Other Risks Indemnity Scheme (CNORIS)
Scheme Contractor – NHS National Services Scotland (NSS) manage the scheme on behalf of Scottish Government.
Scottish Government Scheme Manager – the lead individual within Scottish Government Health & Social Care Directorates with responsibility for the policy and operation of the CNORIS scheme
NHSScotland – the publicly funded healthcare system for people in Scotland.
NHS Boards – the individual territorial and Special Health Boards with direct responsibility for patient care in Scotland and who comprise the scheme membership.
Integration Joint Boards – bodies established to take responsibility for functions delegated by Local Authorities and Health Boards in regard to Health and Social Care Services.
CNORIS Key Aims & Objectives: To encourage a rigorous and logical approach to risk management in both the clinical and
non-clinical sectors of Health and Social Care services in Scotland;
To provide advice on clinical and non-clinical scheme coverage to all parts of Health and Social Care services in Scotland;
To support scheme members in an advisory capacity in order to reduce their risks;
To indemnify scheme members against losses which qualify for scheme cover;
To allocate equitable contributions amongst Members to fund their qualifying losses;
To provide Members with scheme financial updates throughout the year to help with planning and forecasting;
To help manage risk by providing Members with clinical and non-clinical loss analysis throughout the year
NHS National Services Scotland — Supporting Scotland's Health
Appendix 2: Organisations covered by the CNORIS are as follows*:
NHS 24 NHS Lanarkshire
NHS Ayrshire and Arran North Lanarkshire Integration Joint Board
East Ayrshire Integration Joint Board South Lanarkshire Integration Joint Board
North Ayrshire Integration Joint Board NHS Lothian
South Ayrshire Integration Joint Board Midlothian Integration Joint Board
NHS Borders West Lothian Integration Joint Board
NHS Dumfries and Galloway Mental Welfare Commission for Scotland
Dumfries and Galloway Integration Joint Board National Services Scotland
NHS Education for Scotland National Waiting Times Centre
NHS Fife NHS Orkney
Fife Integration Joint Board NHS Quality Improvement Scotland
NHS Forth Valley Scottish Ambulance Service
NHS Grampian NHS Shetland
Aberdeenshire Integration Joint Board Shetland Islands Integration Joint Board
NHS Greater Glasgow and Clyde The State Hospital
Glasgow City Integration Joint Board NHS Tayside
East Dunbartonshire Integration Joint Board Angus Integration Joint Board
West Dunbartonshire Integration Joint Board Dundee City Integration Joint Board
Renfrewshire Integration Joint Board Perth and Kinross Integration Joint Board
NHS Health Scotland NHS Western Isles
NHS Highland
* As at 31 March 2016
NHS National Services Scotland — Supporting Scotland's Health
NOTES
1 Refer to Appendix 2 for a list of all CNORIS members as at 31 March 2016
2 Through the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS) members contribute annually to the CNORIS fund for meeting the award costs and legal expenses in regard to any claims for negligence pursued by patients, employees, third parties and members of the public.
Members are reimbursed for the costs incurred, less the relevant deductible value per individual claim, in regard to award payments made to claimants, the claimants legal costs and the members’ own legal expenses in any given year. The deductible value for claims raised since 2001 is £25,000 per claim; previously £75,000 or £100,000 was applicable.
The CNORIS Annual Report provides details in regard to the historical reimbursements paid to members of the Scheme from CNORIS in any given financial year (1 April to 31 March). The figures quoted do not include any costs not reimbursed to members, but include any interim awards where claimants have received payments in advance of settlement and PPO payments.
The CNORIS Annual Report does not provide information in regard to the total number and value of claims settled by members.
3 Information based upon Official Statistics provided by NSS / ISD on their website.
4 Clinical negligence claims relate to those incidents whereby the care and treatment by medical, nursing and other healthcare professionals is considered to have been below expected standards and caused harm.
5 The non-clinical areas covered by CNORIS include: employers liability, public liability, product liability and non-clinical professional risks. Refer to the CNORIS website for further details.
6 Periodic Payment Orders (PPOs) and Structured Settlements are where instead of receiving a lump sum award payment claimants receive periodic payments (normally annually) for a defined number of years, or life depending upon what is agreed. PPOs are primarily agreed where there are ongoing costs associated with the care and wellbeing of the claimant and/or their family/guardians, such as the costs associated with the ongoing care of a severely disabled child into adulthood.
7 A Pipeline Analysis is being used in this instance as a method of comparing, on a like for like basis, the number and value of claims over time.
8 All claims are evaluated and allocated a risk rating based upon the probability of the outcome resulting in a settlement being made to a claimant. Risk ratings are re-assessed as claims are progressed and new information reduces the uncertainty of outcomes.
9 For further information refer to the Scottish Government website pages for CNORIS.
10 For further information refer to the Government website on legislation
